Buprenorphine versus methadone for the treatment of opioid dependence: a systematic review and meta-analysis of randomised and observational studies

Degenhardt, Louisa; Clark, Brodie; Macpherson, Georgina; Leppan, Oscar; Nielsen, Suzanne; Zahra, Emma; Larance, Briony; Kimber, Jo; Martino-Burke, Daniel; Hickman, Matthew; Farrell, Michael

doi:10.1016/s2215-0366(23)00095-0

Cited by 43 publications

(8 citation statements)

References 111 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, a recent systematic review indicated that MMT generally yielded better overall treatment retention than sublingual BNX, potentially from client-centred factors, such as preferences in treatment. 49 However, it is worth noting that while there were differences in retention in assigned OAT based on OAT type, there were no significant differences in overall retention (i.e., any OAT) between participants receiving BNX or MMT. This latter finding is consistent with the results from the main OPTIMA paper 45 and other studies, 50 , 51 which indicate that individuals with OUD receiving BNX were more inclined to switch rather than discontinue OAT altogether.…”

Section: Discussionmentioning

confidence: 82%

The Association Between Self-Reported Anxiety and Retention in Opioid Agonist Therapy: Findings From a Canadian Pragmatic Trial

Bahji,

Bastien,

Bach

et al. 2023

Can J Psychiatry

View full text Add to dashboard Cite

Background Prescription-type opioid use disorder (POUD) is often accompanied by comorbid anxiety, yet the impact of anxiety on retention in opioid agonist therapy (OAT) is unclear. Therefore, this study investigated whether baseline anxiety severity affects retention in OAT and whether this effect differs by OAT type (methadone maintenance therapy (MMT) vs. buprenorphine/naloxone (BNX)). Methods This secondary analysis used data from a pan-Canadian randomized trial comparing flexible take-home dosing BNX and standard supervised MMT for 24 weeks. The study included 268 adults with POUD. Baseline anxiety was assessed using the Beck Anxiety Inventory (BAI), with BAI ≥ 16 indicating moderate-to-severe anxiety. The primary outcomes were retention in assigned and any OAT at week 24. In addition, the impact of anxiety severity on retention was examined, and assigned OAT was considered an effect modifier. Results Of the participants, 176 (65%) reported moderate-to-severe baseline anxiety. In adjusted analyses, there was no significant difference in retention between those with BAI ≥ 16 and those with BAI < 16 assigned (29% vs. 28%; odds ratio (OR) = 2.03, 95% confidence interval (CI) = 0.94–4.40; P = 0.07) or any OAT (35% vs. 34%; OR = 1.57, 95% CI = 0.77–3.21; P = 0.21). In addition, there was no significant effect modification by OAT type for retention in assigned ( P = 0.41) or any OAT ( P = 0.71). In adjusted analyses, greater retention in treatment was associated with BNX (vs. MMT), male gender identity (vs. female, transgender, or other), enrolment in the Quebec study site (vs. other sites), and absence of a positive urine drug screen for stimulants at baseline. Conclusions Baseline anxiety severity did not significantly impact retention in OAT for adults with POUD, and there was no significant effect modification by OAT type. However, the overall retention rates were low, highlighting the need to develop new strategies to minimize the risk of attrition from treatment. Clinical Trial Registration This study was registered in ClinicalTrials.gov (NCT03033732).

show abstract

Section: Discussionmentioning

confidence: 82%

The Association Between Self-Reported Anxiety and Retention in Opioid Agonist Therapy: Findings From a Canadian Pragmatic Trial

Bahji,

Bastien,

Bach

et al. 2023

Can J Psychiatry

View full text Add to dashboard Cite

show abstract

“…However, buprenorphine is thought to have a lower risk of respiratory depression and accidental overdose as compared to Methadone and other full mu opioid agonists. In addition, while a recent systematic review found that retention in OUD treatment programs was better for methadone than for buprenorphine, there was no evidence suggesting that adherence differed between the medications [21 ▪ ]. For these reasons, there has been widespread adoption of buprenorphine for the treatment of mild to moderate pain and OUD.…”

Section: Buprenorphinementioning

confidence: 99%

Perioperative pain optimization in the age of the opioid epidemic

Patel,

Snyder,

Brooks

2024

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

Purpose of review The opioid epidemic remains a constant and increasing threat to our society with overdoses and overdose deaths rising significantly during the COVID-19 pandemic. Growing evidence suggests a link between perioperative opioid use, postoperative opioid prescribing, and the development of opioid use disorder (OUD). As a result, strategies to better optimize pain management during the perioperative period are urgently needed. The purpose of this review is to summarize the most recent multimodal analgesia (MMA) recommendations, summarize evidence for efficacy surrounding the increased utilization of Enhanced Recovery After Surgery (ERAS) protocols, and discuss the implications for rising use of buprenorphine for OUD patients who present for surgery. In addition, this review will explore opportunities to expand our treatment of complex patients via transitional pain services. Recent findings There is ample evidence to support the benefits of MMA. However, optimal drug combinations remain understudied, presenting a target area for future research. ERAS protocols provide a more systematic and targeted approach for implementing MMA. ERAS protocols also allow for a more comprehensive approach to perioperative pain management by necessitating the involvement of surgical specialists. Increasingly, OUD patients taking buprenorphine are presenting for surgery. Recent guidance from a multisociety OUD working group recommends that buprenorphine not be routinely discontinued or tapered perioperatively. Lastly, there is emerging evidence to justify the use of transitional pain services for more comprehensive treatment of complex patients, like those with chronic pain, preoperative opioid tolerance, or substance use disorder. Summary Perioperative physicians must be aware of the impact of the opioid epidemic and explore methods like MMA techniques, ERAS protocols, and transitional pain services to improve the perioperative pain experience and decrease the risks of opioid-related harm.

show abstract

“…However, they also rank among the most frequently misused and abused medications, such as oxycodone, hydrocodone, and especially fentanyl (the wave of overdose deaths attributed to illicit fentanyl since 2013 is unprecedented) [ 2 , 46 ]. Traditional pharmacological therapies, such as the mu-opioid receptor (MOR) agonists methadone and buprenorphine, have been useful in treating opioid dependence [ 47 , 48 ]. Additionally, MOR antagonists like naltrexone and naloxone are effective in reversing opioid overdoses [ 49 ].…”

Section: Recent Progress In Anti-drug Vaccine Researchmentioning

confidence: 99%

Vaccines to Treat Substance Use Disorders: Current Status and Future Directions

Lu,

Li,

Zheng

et al. 2024

Pharmaceutics

View full text Add to dashboard Cite

Addiction, particularly in relation to psychostimulants and opioids, persists as a global health crisis with profound social and economic ramifications. Traditional interventions, including medications and behavioral therapies, often encounter limited success due to the chronic and relapsing nature of addictive disorders. Consequently, there is significant interest in the development of innovative therapeutics to counteract the effects of abused substances. In recent years, vaccines have emerged as a novel and promising strategy to tackle addiction. Anti-drug vaccines are designed to stimulate the immune system to produce antibodies that bind to addictive compounds, such as nicotine, cocaine, morphine, methamphetamine, and heroin. These antibodies effectively neutralize the target molecules, preventing them from reaching the brain and eliciting their rewarding effects. By obstructing the rewarding sensations associated with substance use, vaccines aim to reduce cravings and the motivation to engage in drug use. Although anti-drug vaccines hold significant potential, challenges remain in their development and implementation. The reversibility of vaccination and the potential for combining vaccines with other addiction treatments offer promise for improving addiction outcomes. This review provides an overview of anti-drug vaccines, their mechanisms of action, and their potential impact on treatment for substance use disorders. Furthermore, this review summarizes recent advancements in vaccine development for each specific drug, offering insights for the development of more effective and personalized treatments capable of addressing the distinct challenges posed by various abused substances.

show abstract

Buprenorphine versus methadone for the treatment of opioid dependence: a systematic review and meta-analysis of randomised and observational studies

Cited by 43 publications

References 111 publications

The Association Between Self-Reported Anxiety and Retention in Opioid Agonist Therapy: Findings From a Canadian Pragmatic Trial

The Association Between Self-Reported Anxiety and Retention in Opioid Agonist Therapy: Findings From a Canadian Pragmatic Trial

Perioperative pain optimization in the age of the opioid epidemic

Vaccines to Treat Substance Use Disorders: Current Status and Future Directions

Contact Info

Product

Resources

About